Should community drinking water be fluoridated?

COMMUNITY WATER FLUORIDATION has long been hailed as an effective way to reduce tooth decay. Its supporters say that decades of research have shown the practice to be safe when the correct amounts of fluoride are added to public water supplies. Critics, however, question the safety and efficacy of water fluoridation at any dose. They add that it is an infringement of individuals’ rights to be automatically medicated via public drinking water.

What do you think?

From an expert in the field:Howard Pollick is a clinical professor of preventive and restorative dentistry and a member of the American Dental Association’s National Fluoridation Advisory Committee (www.ada.org).

FLUORIDE IS nature’s cavity fighter. It is naturally present in all water. Community water fluoridation is simply the adjustment of the amount of naturally occurring fluoride to the recommended amount to help prevent tooth decay. Fluoridated water is regulated by sophisticated controls under direct supervision by trained water engineers.

Because of its role in preventing cavities, fluoridation of community water supplies has been proclaimed by the Centers for Disease Control and Prevention as one of 10 great public health achievements of the 20th century.

Studies show that community water fluoridation prevents at least 25 percent of tooth decay in children and adults. On an individual basis, the lifetime cost of fluoridation is less than the cost of one dental filling. For communities, every $1 invested in water fluoridation saves $38 in dental treatment costs.

Critics often point to dental fluorosis as a result of fluoridated drinking water. Dental fluorosis is not a disease but rather a change in the way teeth look. The vast majority of fluorosis appears as barely noticeable faint white lines or streaks on tooth enamel. This type of fluorosis has no effect on tooth function and may make the tooth enamel more resistant to decay,.

Critics also allege that fluoridated water is associated with lower IQ. However, the studies do not stand up to scientific scrutiny. Both the 2006 National Research Council report and an independent review from England noted many study limitations that make it difficult, if not impossible, to assess these studies’ validity.

For example: Many of the papers omitted important procedural details; not all of the studies identify the level of fluoride in the water where the children lived; the studies did not take into account other factors than can affect IQ, such as poverty, exposure to heavy metal pollution (arsenic and lead) and dietary deficiencies; and the majority of the studies are from China, India and Mexico, where environmental conditions are significantly different from those in the U.S.

The bottom line is that water fluoridation remains the single most effective public health measure to prevent tooth decay. That is why the past five surgeons general and organizations such as the American Dental Association, American Academy of Pediatrics, American Medical Association and more than 100 other international organizations recognize the public health benefits of fluoridation.

From an expert in the field:
Paul Connett is co-author of The Case Against Fluoride (Chelsea Green, 2010) and director of the Fluoride Action Network (www.fluoridealert.org).

MOST COUNTRIES in the world (including 97 percent of Europe) do not fluoridate their water. Yet, tooth decay has been coming down as fast in non-fluroidated countries as in fluoridated ones, according to a World Health Organization study.

It is a poor medical practice to use the water supply to deliver medicine. You cannot control the dose or who gets the medicine, and it violates the individual’s right to informed consent to medical treatment.

U.S. government-funded studies cited in the Journal of Dental Research and the Journal of Public Health Dentistry indicate that the evidence supporting swallowing fluoride to reduce tooth decay is very weak. Even the Centers for Disease Control and Prevention (CDC) admits that the predominant benefit of fluoride comes from topical, not systemic, application. Fluoride works on the surface of the tooth, not from inside the body. Thus, there is no need to swallow fluoride and no need to force it on people who don’t want it.

Proponents argue that the level at which we fluoridate –1 part per million (ppm)- is so small that it couldn’t possibly hurt anyone. However, 1 ppm is 250 times the level found in mother’s milk. It is reckless to give a bottle-fed baby 250 times more fluoride than nature intended.

Today our children are being grossly overexposed to fluoride, as evidenced by a CDC study indicating that 41 percent of U.S. children age 12 to 15 have dental fluorosis (irreversible damage to the enamel). More worrying are the many animal and human studies showing that fluoride is a neurotoxin. For example, a Harvard team showed that out of 27 studies, 26 found a lowering of IQ in children exposed to fluoride, with an average loss of 7 IQ points, which is substantial.

Fluoridation proponents have argued that this meta-analysis can be ignored because the fluoride concentrations were much higher than the levels used in fluoridation. But this is simply not true. In nine of the studies the concentrations were less than 3 ppm. This leaves no adequate margin of safety to protect all our children from damage to their developing brains.

Alternative solutions are available. The Childsmile program in Scotland has show that large reductions in tooth decay can be achieved in low-income families with cost-effective programs involving teaching tooth-brushing in nursery schools, educating parents on better diets and providing topical fluoride varnishes to those most vulnerable. Our reckless practice of fluoridating public drinking water must be brought to an end as soon as possible.